Impaired mandibular growth and micrognathic development in children with juvenile rheumatoid arthritis. A longitudinal study of lateral cephalographs

Abstract

The present report is a longitudinal study of the craniofacial growth, based on lateral cephalographs of a group of 26 patients with juvenile rheumatoid arthritis (JRA), and a matched English control group. In the 26 matched pairs, the mean age at baseline was 8.4 years and at 6-year follow-up 14.7 years, female/male ratio was 3.3/1, and all patients had temporomandibular joint (TMJ) abnormalities. The study revealed obvious growth disturbances in the facial skeleton in the children with JRA. Compared with the controls, the patients showed a smaller mandible with an altered morphology and position. The mandible became more retruded by rotating posteriorly, around a centre in the molar region, and was characterized by appositional growth in the gonion area, vertical growth in the anterior part and proclination of the lower incisors. During the observation period the growth disturbances became more pronounced, reflecting the progressive nature of the abnormal development. Based on these findings, a future aspect of research in this field could be TMJ surgery and orthognathic surgery in an early stage, trying to avoid this unfavourable facial development.

Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs:A case control study

“…2 The arthritis might lead to severe destruction of the cartilage and underlying bone, which can result in a deviating growth of the face. [3][4][5][6][7][8][9] To reduce these growth disturbances by early interventions, it is recommended that children with JIA be referred to a dentist for follow-up of facial growth and condylar destruction, especially as clinical and radiologic signs of inflammation are not always present, even though growth disturbances can be seen radiographically. 6 On the radiographs taken to evaluate facial growth, at least four vertebrae of the upper part of the cervical spine are usually visible.…”

Dental and facial characteristics of patients with juvenile idiopathic arthritis

“…Chronic inflammation in this joint results in degenerative alterations and the presence of signs and symptoms of dysfunction, such as pain, TMJ noises, and limited movement. Alterations in facial growth, such as micrognathia, retrognathia, facial asymmetry, and anterior open bite, also occur due to condylar involvement [3][4][5][6][7] . The teeth and gingiva can be indirectly affected by JIA due to physical limitations in the superior limbs of these patients, which make performing adequate oral hygiene difficult, contributing to the higher incidence of dental and gingival pathology 8,9 .…”

Juvenile idiopathic arthritis—and now?

“…Diese konnte entweder unbehandelt oder kieferorthopädisch behandelt sein, sofern die Intervention spezifiziert worden war. [4,9,11,20,40] so that it can be assumed that disease-free joints distort the results ( Table 5, Table 6). The patients' age range was clearly defined in just 5 of the 19 publications.…”

“…Eight groups of authors conducted a comparison with a control group matched according to age and gender [1,4,6,10,11,13,20,40], but only four described the occlusion of the control group [13,20,36,39], and only two [6,10] report whether the control group had undergone orthodontic therapy. The type of orthodontic treatment, however, remains unknown (Table 7).…”

“…Im Großteil der Untersuchungen fand zwar eine Angabe, nicht aber eine differenzierte Analyse der verschiedenen JIA-Subtypen statt. So analysierten acht der 19 Autorengruppen alle JIAArten gepoolt [1,4,6,10,11,13,46,47], drei fassten die drei Hauptarten (Oligo-, Poly-, systemische Arthritis) zusammen [15,36,39] und weitere sieben untersuchten Patienten mit Oligo-und Polyarthritis [9,20,25,26,27,39,40]. Lediglich eine Studie beschränkte sich spezifisch auf Patienten mit einer systemischen Manifestation der Erkrankung ( [12], Tabelle 4).…”